Frozen Shoulder

Frozen Shoulder

Frozen shoulder affects about 3% of adults, and usually affects more women than men.

You may notice and ignore a bit of a ‘shoulder niggle’ now and then, until those niggles begin to be a bit more persistent.

Frozen shoulder often continues with shoulder pain when moving your arm and gradually progresses to stiffness and a very limited range of motion. The pain and stiffness can be extreme, especially when you try to raise your arm to the side, or if your arm gets pulled on by, say, a dog or a small child.

The pain and stiffness gets in the way of reaching for objects, holding kettles, doing up a bra strap, or putting your arm into the sleeve of a jacket. The pain also interferes with sleep, which has the knock on effect of making the pain harder to manage.

You may experience feelings of cold or tingling in the arm, and very often your neck or upper back will uncomfortable as you try to avoid things that may hurt your shoulder.

Frozen shoulder occurs when the tissue capsule that holds the bones, ligaments and tendons of the shoulder thickens and sticks together. When the joint capsule tightens like this, it squeezes the structures inside and reduces the space in which they can move. The joint membrane that lines this capsule doesn’t lubricate the joint well enough and all of this, and possibly neurological changes within the joint and in the surrounding muscles is what causes the pain and stiffness.

Frozen shoulder has three main stages:

Phase 1: Freezing – night pain and painful movements that become harder to do as the shoulder capsule clamps down on the joint

Phase 2: Frozen – less pain at night, but extreme pain when moving suddenly and very restricted movement

Phase 3: Thawing – movement begins to return as the capsule begins to thin and relax. Often people will start hearing and feeling clicking in the shoulder.

Left alone, frozen shoulder can take an average of 34 months to pass. That is almost 3 years!

Niel Asher Technique

Although the technique began in it’s development before a lot of the newest research on pain physiology, it lines up quite nicely with what we know about freezing and frozen shoulders and how our body and brain must connect to heal and more rapidly recover.

The technique not only helps with the actual physical trigger points, muscle and capsule of the shoulder joint. It also ‘uses the body’ to stimulate the nervous system in such a way that it helps interrupt the pain/stiffness/guarding cycle.

Step One: Outside of Arm

The first step in the process has you laying on your side with your affected shoulder facing up.

The first moves work along the outside of the muscles of the arm, sometimes all the way from the elbow to the top of the shoulder. You may feel pressure, a few ‘bubbles’, but you shouldn’t feel pain. The movement of my hand is much like that of squeezing toothpaste out of a tube. I may also work into specific areas. The speed of the moves and the depth will depend on your tolerance and what phase you are in.

Step Two: Behind the Shoulder

The second step involves treating trigger points in the back of the shoulder using firm pressure. This can sometimes be uncomfortable, but it’s really important to me that you tell me if you’re in pain. We want to break that cycle of pain and I want you to be as comfortable as you can be.

Step Three: Movements

The third step is often the trickiest for patients – not because it is complicated but because it requires trust. Your history of treatment may have involved lots of rough handling, but this is not rough at all.

I would take the full weight of your arm and move it very slowly in small circles, inside the ‘barrier’ where you usually feel pain. I will move your arm very slowly and gently until this area is well mapped out, and then perform very gentle movements.

What is very interesting about this is that often you will have move movement when I do the movement for you than when you try to do the movement yourself.

This not only helps encourage ‘unsticking’ within the shoulder by flushing fluids around inside the capsule, but it helps ‘wire’ your nervous system to start to recognise that you have more movement available. We later connect these two parts with exercise rehabilitation and aftercare.

Step Four: Front of the Arm

This part of the technique addresses the front of the arm – the biceps muscle and the biceps tendon where it enters the shoulder capsule. This part of the technique, again, requires firm pressure. I will also often treat trigger points in the pectoral muscle while I am working in this area, to help reduce tension which prevents the arm from being able to turn inward and pull backward at the same time (as in when putting on a jacket).

There are slight modifications in steps 4 and 5 depending upon the person, however this is the general outline of what to expect, particularly in a first treatment.

Step Five: Back of the Shoulder Blade

This step involves treating the shoulder blade and behind the shoulder with firm pressures, and sometimes with movements of the arm as well.

It is not uncommon for people to feel radiating heat or discomfort through to the front of the shoulder during this step of the process.

NAT Rythms

In most people, this cycle of steps will be repeated two to three times depending upon what phase of frozen shoulder they are in. Different steps may be emphasized differently depending upon treatment progress and occasionally – for example if you have two frozen shoulders – you may be in slightly different positions to prevent you from having to lay on a painful shoulder whilst the other shoulder is worked on.

NAT Aftercare

Your aftercare advice will be specifically tailored to you. Every frozen shoulder is different and so each aftercare advice set will emphasize different movements and exercises.